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British and European palliative care physicians are not alone in
their concerns and reluctance to participate in Physician Assisted
Suicide/Euthanasia. Canadian Palliative care physicians struggle with this
issue as well.
In 2010, the Canadian Society of Palliative Care physicians (300 members)
were surveyed. (1) The questions were specific: "Are you for or against
PAS/Euthanasia?" "Would you provide assisted suicide?" "W...

British and European palliative care physicians are not alone in
their concerns and reluctance to participate in Physician Assisted
Suicide/Euthanasia. Canadian Palliative care physicians struggle with this
issue as well.
In 2010, the Canadian Society of Palliative Care physicians (300 members)
were surveyed. (1) The questions were specific: "Are you for or against
PAS/Euthanasia?" "Would you provide assisted suicide?" "Would you provide
Euthanasia?" Forty-six percent of the membership responded to the survey.
The overwhelming majority was opposed to the legalization of euthanasia
(88%) or assisted suicide (80%). Ninety percent of responding members
would not be willing to participate in the act of euthanasia and 83% of
responding members would not be willing to aid in assisted suicide.
The Society followed with another survey in 2015 in response to the
growing public interest and in anticipation of a Supreme Court Ruling. The
January 2015 survey (350 members with a 74% response rate) indicated that
the majority of the membership was still opposed to legalization of
euthanasia (73%) or assisted suicide (69%). The majority (74%) believe
that euthanasia and physician assisted suicide, if legalized, should not
be provided by palliative care services or palliative care physicians. (2)
The Carter Decision (Carter v. Canada (Attorney General), 2015 SCC 5)
struck down the prohibition on assisted suicide, opening the way for new
legislation to enable physician assisted death for people with a "grievous
and irremediable medical condition". (3) There is no mention in the
decision that these people have to be terminally ill, nor are there any
specifications around assessment, restrictions, or processes. This Supreme
Court decision is one of the most liberal in the world. In opening up this
service to people without terminal illnesses it thereby makes this an
issue for all physicians, not just those in palliative care.
Canadian physicians are currently struggling with the implications this
decision has for their practice, their patients and their internal belief
as to what it means to be a physician. While the Canadian Medical
Association has stated that physicians can follow their conscience (4)
this will have to be balanced with the needs of the patients. Health care
in Canada is provincially funded and regulated, meaning that each province
could come up with its own way of providing physician assisted death.
Quebec has already done so. Physicians have urged government to engage in
a thoughtful, inclusive process to create the new laws and medical systems
but with a federal election poised for the fall, little has been heard on
this subject. Provincial Medical Colleges are left, in this void of
legislation, to scramble to come up with rules and regulations for this
new service. As of February 6, 2016, the prohibition against physician
assisted suicide will be gone and potentially no legislation or decisions
around practice will be in place.

Susan MacDonald MD CCFP FCFP
President, Canadian Society of Palliative Care Physicians
Associate Professor of Medicine and Family Medicine, Memorial University
of Newfoundland